By whatever name it may be called there is lack of appetite, a sense of malaise, indisposition to either mental or physical activity, drowsiness, often giddiness, a bad taste in the mouth and a bad breath, the tongue is covered with a rather thick slimy coating, there is inactivity of the bowels and a peculiar "bilious" color in the skin, dark circles under the eyes and usually there is a severe and distressing headache. Sooner or later there will be nausea and vomiting. The vomited matter is a liquid, yellow, or greenish yellow in color and as "bitter as gall." This condition has been seen by every one and experienced by most persons.

A condition of this sort confronts the "family doctor" more often, perhaps, than all others combined.

Gallstones forming in the gall bladder sometimes stop up the gall ducts and prevent the flow of bile into the intestines. This dammed up bile is then reabsorbed into the blood and carried throughout the system and deposited in every tissue of the body. .This deposited bile pigment is what gives to the skin and the whites of the eyes that "yellow as a pumpkin" jaundiced color.

In at least a great many cases of socalled "biliousness" there is a slightly analagous condition caused by a concentration of the bile. This interferes with its normal flow and results in its reabsorption into the blood, to be partly deposited in the tissues and partly to be re-eliminated by the liver. With each cycle, of course, it becomes more and more concentrated. In biliousness the bile is not dammed up as in gallstones but because of the impeded flow of the thickened bile there is reabsorption into the blood and a deposit of bile pigment into the tissues.

Because of the inactivity of the bowels in this condition there is necessarily a reabsorption also of the poisons from uneliminated waste in the intestines and this poison or toxin together with the reabsorbed bile gives rise to many of the symptoms noticed.

Inseparably linked with the word biliousness is that other word, calomel. Calomel has a double action. It is a purgative and also a cholagogue (bile driver), hence calomel in "biliousness" empties the intestinal tract and also liquefies the bile and stimulates the liver cells to excrete more bile. Thus with the intestines emptied the bile ducts and gall bladder emptied and the liver cells filtering out of the blood the accumulated bile the condition speedily clears up.

Calomel, however, has its disadvantages. It is of itself a very poor purgative and should never be taken, except upon the specific advice of a physician. When taken into the stomach and absorbed into the blood it is an excellent stimulant to liver activity. Its absorption is rather slow, hence should be taken in the minimum needed doses to accomplish this purpose and given time to be absorbed before a purgative is taken to empty the bowels.

Epsom salts and castor oil are excellent purgatives. They do quickly and thoroughly empty the intestinal tract but they have no stimulating action on the liver and do not liquefy the bile. These drugs by themselves will not clear up the symptoms of the condition popularly known as biliousness.

If, however, the bowel contents are never allowed to stagnate, then biliousness is much less likely to occur, and such drugs are much more valuable in preventing biliousness than in curing it. In recent years a mechanical method has been devised of draining the gall bladder without the use of purgation. It consists in the passage of a small tube by swallowing it very like a stomach tube through the stomach and into the duodenum (the upper small intestine). The procedure is simple and usually gives the patient little inconvenience but does require some time. In cases where indicated it often gives most happy results.

"Biliousness" may not be the proper name for it but the condition described is very real and very common. It is relieved by anything that empties the bowels to stop further toxemia and by emptying the gall bladder and clearing from the body tissues the accumulated bile and waste products.